Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kimberly Modena Tatum, NURSEPRACTITIONER

Individual provider Family Nurse Practitioner · NPI 1518479542

Kimberly Modena Tatum, NURSEPRACTITIONER is a Nurse Practitioner in Palestine, Texas. Qualified in 2017, 9 years ago. Practices with Tyler Family Circle of Care, a 28-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
9
Licensed in
TX
In the registry since
2017
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Practice location Address checks out

4002 S Loop 256 Ste A
Palestine, TX 75801-8492
Phone: (903) 731-5030
Fax: (903) 731-5037
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence AP136159 (TX)

Record details

NPI number1518479542
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorYes
NPI enumeratedOctober 31, 2017
Last updated in NPPESOctober 21, 2024
Certification dateOctober 21, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Tyler Family Circle Of Care — 28 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Palestine